KCE Repository
Not a member yet
1732 research outputs found
Sort by
Impact of shortened length of stay for delivery on the required bed capacity in maternity services : results from forecast analysis on administrative data
No full text9 p.Background: We examine the implications of reducing the average length of stay (ALOS) for a delivery on the required capacity in terms of service volume and maternity beds in Belgium, using administrative data covering all inpatient stays in Belgian general hospitals over the period 2003–2014.
Methods: A projection model generates forecasts of all inpatient and day-care services with a time horizon of 2025. It adjusts the observed hospital use in 2014 to the combined effect of three evolutions: the change in population size and composition, the time trend evolution of ALOS, and the time trend evolution of the admission rates. In addition, we develop an alternative scenario to evaluate the impact of an accelerated reduction of ALOS.
Results: Between 2014 and 2025, we expect the number of deliveries to increase by 4.41%, and the number of stays in maternity services by 3.38%. At the same time, a reduction in ALOS is projected for all types of deliveries. The required capacity for maternity beds will decrease by 17%. In case of an accelerated reduction of the ALOS to reach international standards, this required capacity for maternity beds will decrease by more than 30%.
Conclusions: Despite an expected increase in the number of deliveries, future hospital capacity in terms of maternity beds can be considerably reduced in Belgium, due to the continuing reduction of ALOS
De rol van statines bij de primaire preventie van hart- en vaatincidenten : Synthese
No full text15 p.ill.,VOORWOORD 1 -- KERN BOODSCHAPPEN 2 -- SAMENVATTING 3 -- 1. DOEL VAN DE STUDIE.4 -- WAT ZIJN STATINES? 4 -- WAT HEBBEN WE ONDERZOCHT? .5 -- HOE GINGEN WE TE WERK? 5 -- 2. GEBRUIK VAN STATINES IN BELGIË 6 -- OP DE BELGISCHE MARKT SINDS DE JAREN 1990.6 -- 13% VAN DE GEHELE BELGISCHE BEVOLKING GEBRUIKT STATINE.7 -- … MAAR HOUDT DE BEHANDELING MEESTAL NIET VOL 7 -- DOELTREFFEND VOOR PRIMAIRE PREVENTI 8 -- … MAAR TOCH BIJWERKINGEN 9 -- 3. WAT IS DE KOSTENEFFECTIVITEIT VAN STATINES BIJ DE PRIMAIRE PREVENTIE? 10 -- KOSTENEFFECTIVITEIT WORDT DOOR VELE FACTOREN BEÏNVLOED.10 -- BETERE KOSTENEFFECTIVITEIT VOOR MENSEN MET EEN HOGER RISICO.11 -- 4. CONCLUSIE: AANPASSING VAN LEVENSSTIJL BLIJFT HET BELANGRIJKSTE 12 -- AANBEVELINGEN 13 -- REFERENTIES 1
Performance of the Belgian health system : Report 2019
No full text109 p.ill.,FOREWORD 1 -- LIST OF FIGURES 4 -- LIST OF TABLES 4 -- LIST OF ABBREVIATIONS 5 -- 1 CONTEXT AND OBJECTIVES 8 -- 1.1 INTRODUCTION 8 -- 1.2 INTERNATIONAL INITIATIVES 8 -- 1.3 CONCEPTUAL FRAMEWORK 10 -- 1.4 OBJECTIVES OF THE 2019 REPORT 10 -- 2 METHODS AND DATA 12 -- 2.1 SELECTION OF INDICATORS AND SOURCES OF DATA 12 -- 2.2 WHAT’S NEW IN THIS REPORT COMPARED TO THE PREVIOUS ONE? 13 -- 2.3 HOW DID WE PERFORM THE EVALUATION? 13 -- 3 QUALITY OF CARE 15 -- 3.1.1 Effectiveness of care 15 -- 3.1.2 Appropriateness of care 19 -- 3.1.3 Safety of care 24 -- 3.1.4 Continuity of care 27 -- 3.1.5 Patient centeredness 31 -- 4 ACCESSIBILITY OF CARE 35 -- 5 EFFICIENCY OF THE HEALTHCARE SYSTEM 44 -- 6 SUSTAINABILITY OF THE HEALTHCARE SYSTEM 46 -- 7 EQUITY AND INEQUALITIES 52 -- 7.1 SOCIOECONOMIC INEQUALITIES IN USE OF HEALTH SERVICES 52 -- 7.2 CONTEXTUAL INDICATORS OF EQUITY 58 -- 8 PREVENTIVE CARE 61 -- 9 MENTAL HEALTHCARE 65 -- 10 LONG-TERM AND ACUTE CARE FOR THE ELDERLY 68 -- 11 CARE AT THE END OF LIFE 75 -- 12 MOTHER AND NEWBORN CARE 78 -- 13 HIGHLIGHTS ON STRENGTHS AND WEAKNESSES OF THE BELGIAN HEALTH SYSTEM 82 -- 14 BELGIAN HSPA AND POLICY PROCESS 84 -- 14.1 THE BELGIAN HSPA IN THE POLICY PROCESS 84 -- 14.2 HEALTH SYSTEM TARGETS 86 -- 15 CONCLUSION 87 -- RECOMMENDATIONS 90 -- APPENDIX 93 -- APPENDIX 1. LIST OF INDICATORS 93 -- BIBLIOGRAPHY 9
Performance of the Belgian health system : Report 2019 - – Supplement: rejected indicators
No full text6 p.ill.,Table 1 – Quality of care – safety: rejected indicators 2 -- Table 2 – Accessibility of care: rejected indicators 2 -- Table 3 – Sustainability of the healthcare system: rejected indicators 3 -- Table 4 – Preventive care: rejected indicators 4 -- Table 5 – Mental health care: rejected indicators 4 -- Table 6 – Care for the elderly: rejected indicators 5 -- Table 7 – Mother and new-born: rejected indicators
Organisation of mental health care for adults in Belgium
No full text450 p.ill.,SCIENTIFIC REPORT 29 -- CHAPTER 00 – OUTLINE OF THE STUDY 29 -- 1 BACKGROUND 29 -- 2 RESEARCH OBJECTIVE 30 -- 3 OUTLINE OF THE STUDY 31 -- 4 LIMITATION/SCOPE OF THE STUDY 31 -- 5 REFERENCES 32 -- CHAPTER 01 DESCRIPTION OF THE BELGIAN MENTAL HEALTH CARE WITHIN THE GENERAL HEALTH CARE ORGANISATION 33 -- AUTHORS: DETOLLENAERE J1, CORNELIS J1, DEVRIESE S1, MISTIAEN P1, RICOUR C1. 33 -- 1 GENERAL ORGANISATION OF THE BELGIAN HEALTH CARE SYSTEM: AN OVERVIEW 33 -- 1.1 PRINCIPLES OF HEALTH CARE ORGANISATION IN BELGIUM 33 -- 1.2 FINANCING OF THE BELGIAN HEALTH CARE SYSTEM 33 -- 2 ORGANISATION OF THE MENTAL HEALTH CARE SYSTEM IN BELGIUM 35 -- 2.1 HISTORICAL OVERVIEW 35 -- 2.1.1 Mental health care organisation in its early days 35 -- 2.1.2 Reforms in Belgian mental health care 36 -- 2.1.3 Sixth institutional state reform 39 -- 2.1.4 Spending on mental health care (problems) 42 -- 2.2 EVALUATION OF THE BELGIAN MENTAL HEALTH CARE SYSTEM 45 -- 2.2.1 Evaluation of the mental health care system in general 45 -- SCIENTIFIC REPORT 29 -- CHAPTER 00 – OUTLINE OF THE STUDY 29 -- 1 BACKGROUND 29 -- 2 RESEARCH OBJECTIVE 30 -- 3 OUTLINE OF THE STUDY 31 -- 4 LIMITATION/SCOPE OF THE STUDY 31 -- 5 REFERENCES 32 -- CHAPTER 01 DESCRIPTION OF THE BELGIAN MENTAL HEALTH CARE WITHIN THE GENERAL HEALTH CARE ORGANISATION 33 -- AUTHORS: DETOLLENAERE J1, CORNELIS J1, DEVRIESE S1, MISTIAEN P1, RICOUR C1. 33 -- 1 GENERAL ORGANISATION OF THE BELGIAN HEALTH CARE SYSTEM: AN OVERVIEW 33 -- 1.1 PRINCIPLES OF HEALTH CARE ORGANISATION IN BELGIUM 33 -- 1.2 FINANCING OF THE BELGIAN HEALTH CARE SYSTEM 33 -- 2 ORGANISATION OF THE MENTAL HEALTH CARE SYSTEM IN BELGIUM 35 -- 2.1 HISTORICAL OVERVIEW 35 -- 2.1.1 Mental health care organisation in its early days 35 -- 2.1.2 Reforms in Belgian mental health care 36 -- 2.1.3 Sixth institutional state reform 39 -- 2.1.4 Spending on mental health care (problems) 42 -- 2.2 EVALUATION OF THE BELGIAN MENTAL HEALTH CARE SYSTEM 45 -- 2.2.1 Evaluation of the mental health care system in general 45 -- AUTHORS: DETOLLENAERE J1, BRUFFAERTS R2, GISLE L3, MISTIAEN P1 66 -- 1 INTRODUCTION 66 -- 2 METHODS 66 -- 2.1 THE EUROPEAN STUDY OF THE EPIDEMIOLOGY OF MENTAL DISORDERS (ESEMED) 66 -- 2.2 THE BELGIAN HEALTH INTERVIEW SURVEY (HIS) 66 -- 3 RESULTS 67 -- 4 CONCLUSION 71 -- 5 KEY MESSAGES 72 -- 6 REFERENCES 72 -- CHAPTER 04 INTERNATIONAL FRAMEWORKS FOR MENTAL HEALTH SERVICE ORGANIZATION 73 -- AUTHORS: RICOUR C1, DETOLLENAERE J1, CORNELIS J1, DEVRIESE S1, MISTIAEN P1. 73 -- 1 INTRODUCTION 73 -- 2 OVERVIEW OF THE FRAMEWORK DEVELOPMENT DURING THE 21TH CENTURY 74 -- 3 DESCRIPTION OF THE DEVELOPED INTERNATIONAL POLICIES 75 -- 3.1 THE WHO MENTAL HEALTH ACTION PLAN 2013-2020 75 -- 3.2 WHO/EUROPE ACTION PLAN 2013-2020 77 -- 3.3 FRAMEWORK FOR ACTION ON MENTAL HEALTH AND WELLBEING 2016 80 -- 3.4 SUSTAINABLE DEVELOPMENT GOALS OF THE UNITED NATIONS AND THE CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES 81 -- 3.5 OECD EVALUATION OF THE IMPACT OF MENTAL HEALTH ILLNESS IN OECD COUNTRIES 82 -- 4 STATUS OF BELGIUM IN THE DIFFERENT SURVEYS ORGANISED BY INTERNATIONAL ORGANISATIONS 83 -- 5 THE BELGIAN ART 107 REFORM PRINCIPLES IN THE LIGHT OF SOME OF THE INTERNATIONAL FRAMEWORKS 84 -- 6 KEY MESSAGES 86 -- 7 REFERENCES 86 -- CHAPTER 05 MAPPING MENTAL HEALTH CARE SERVICES IN BELGIUM 89 -- AUTHORS: LAGUESSE R1, LAMBERT M1, VAN NUFFEL R2, DE COEN M2, VAN SPEYBROECK J2, BONTEMPS C1 89 -- 1 LEXICON 89 -- 2 INTRODUCTION 92 -- 2.1 CONTEXT 92 -- 2.2 HISTORY 92 -- 2.3 BOUNDARIES OF MENTAL HEALTH CARE 93 -- 3 METHOD 95 -- 3.1 TYPE OF DATA AND STRUCTURE OF THEIR DESCRIPTION 95 -- 3.1.1 Distribution of services/institutions by levels 95 -- 3.1.2 Regions 95 -- 3.1.3 Data 95 -- 3.1.4 Overview of the situation 96 -- 3.1.5 Associations and networks involved in mental health 96 -- 3.1.6 Transfer of competences 96 -- 3.2 SCOPE (AND LIMITS OF THE SCOPE) 96 -- 3.2.1 Scope 96 -- 3.2.2 Limitations 96 -- 3.3 DATA DISCUSSION 97 -- 3.4 SOURCES OF DATA 97 -- 4 DESCRIPTION OF SERVICES CATEGORIES 98 -- 4.1 INFORMAL COMMUNITY CARE 98 -- 4.1.1 User associations and family associations 99 -- 4.1.2 Society 99 -- 4.1.3 Non-accredited accommodation structures 101 -- 4.2 MENTAL HEALTH SERVICES THROUGH PRIMARY HEALTH CARE AND RELATED SECTORS101 -- 4.2.1 General practitioner 102 -- 4.2.2 Centre for general welfare 103 -- 4.2.3 Family planning centre 105 -- 4.2.4 Health Relays 105 -- 4.2.5 Aid to maltreated elderly persons 106 -- 4.2.6 Helplines 106 -- 4.2.7 Child abuse 107 -- 4.2.8 Mental health in the related sectors 108 -- 4.3 COMMUNITY MENTAL HEALTH SERVICES AND PSYCHIATRIC SERVICES IN GENERAL HOSPITAL 114 -- 4.3.1 Community mental health centres 115 -- 4.3.2 Mobile teams 117 -- 4.3.3 Day centre 121 -- 4.3.4 Services on addiction 121 -- 4.3.5 Exile services (Wallonia and Brussels) / Psychological care for refugees (Flanders) 122 -- 4.3.6 Ambulatory private or hospital-related practice of mental healthcare professionals 122 -- 4.3.7 Suicide services 124 -- 4.3.8 Specialised rehabilitation centres with convention 125 -- 4.3.9 Psychiatric wards in general hospitals/specialised hospitals 126 -- 4.3.10 Psycho-social services in prisons 126 -- 4.3.11 Initiatives of sheltered living 127 -- 4.3.12 Psychiatric care homes 127 -- 4.4 LONG STAY FACILITIES & SPECIALIST SERVICES 128 -- 4.4.1 Hospitalization units inside psychiatric hospitals 128 -- 4.4.2 Internment 130 -- 4.5 E-MENTAL HEALTH 132 -- 5 OVERVIEW OF THE SECTOR 133 -- 6 THE NETWORKS AND ASSOCIATION OF HEALTH/MENTAL HEALTH CARE ACTORS 143 -- 6.1 THE PSY107 NETWORKS 143 -- 6.2 THE CONSULTATION PLATFORMS IN MENTAL HEALTH 144 -- 6.3 CHILDREN AND ADOLESCENT NETWORKS 145 -- 6.4 THE COORDINATORS OF THE CARE PATH FOR INTERNEES 146 -- 6.5 INTEGRATED CARE SERVICES AT HOME 146 -- 6.6 COORDINATION AND ADDICTION NETWORKS 146 -- 6.6.1 Networks of assistance and specialised care on addictions 146 -- 6.6.2 Flemish expertise centre on alcohol and other drugs 147 -- 6.6.3 Eurotox 147 -- 6.7 REGIONAL COORDINATION IN MH 147 -- 6.7.1 The centre of reference for mental health 147 -- 6.7.2 Mental Health Focal Point 148 -- 6.7.3 French-speaking Brussels league for mental health 148 -- 7 TRANSFER OF COMPETENCES (6TH STATE REFORM) 149 -- 8 DISCUSSION 150 -- 8.1 PRECAUTIONS ABOUT THE COLLECTED DATA 150 -- 8.2 MULTIPLICITY AND DIVERSITY OF THE OFFER 151 -- 8.3 DIVERSITY OF LOCAL AND REGIONAL REALITIES 151 -- 8.4 GAPS IN DATA 152 -- 8.5 COMPLEXITY OF THE OFFER 153 -- 8.6 OVERLAP 154 -- 8.7 ACCESSIBILITY 154 -- 8.8 RESIDENTIAL AND OUTPATIENT MHC 154 -- 8.9 TERRITORIAL COVERAGE 155 -- 8.10 PARTNERSHIPS 155 -- 8.11 COLLABORATION BETWEEN NETWORKS ACCORDING TO AGE GROUPS 155 -- 9 CONCLUSIONS 156 -- 10 SUGGESTIONS FOR RECOMMENDATIONS 158 -- 11 REFERENCES 159 -- CHAPTER 06 STRENGTHS, WEAKNESSES, GAPS, AND OVERLAPS IN THE CURRENT MENTAL HEALTH CARE SUPPLY: A FOCUS GROUP STUDY 166 -- AUTHORS: THUNUS S1, NEYENS I2, WALKER C1, HERMANS K2, SMITH P 1, NICAISE P1, VAN AUDENHOVE C2, LORANT V1 166 -- 1 AN EXPLORATION ON HOW MENTAL HEALTH CARE FOR ADULTS IN BELGIUM IS ORGANISED 166 -- 1.1 OBJECTIVES 166 -- 1.2 MATERIAL AND METHODS 166 -- 1.2.1 Development of focus group material 166 -- 1.2.2 Sampling process 168 -- 1.2.3 Recruitment method 170 -- 1.2.4 Description of sample 170 -- 1.2.5 Data collection 171 -- 1.3 DATA ANALYSIS 172 -- 2 RESULTS 173 -- 2.1 PROVISION OF MENTAL HEALTH CARE 173 -- 2.1.1 Characteristics of the current provision of mental health care 173 -- 2.1.2 Characteristics of providers of mental health care 174 -- 2.1.3 Provision needs 178 -- 2.2 ACCESS TO MENTAL HEALTH CARE 179 -- 2.2.1 Types of services and professionals 179 -- 2.2.2 Access for different groups of service users 181 -- 2.2.3 Access in rural versus urban areas 182 -- 2.3 COLLABORATION AND COORDINATION OF MENTAL HEALTH CARE 182 -- 2.3.1 Values and norms related to mental health care 183 -- 2.3.2 Factors influencing a collaborative culture shift 184 -- 2.3.3 Formal tools 186 -- 2.4 FINANCING OF MENTAL HEALTH CARE 189 -- 2.4.1 Allocation of financing across systems, sectors, services and networks 189 -- 2.4.2 Payment methods for professionals 191 -- 2.4.3 Resources’ allocation and decision-making power 193 -- 2.5 POLITICAL AND SOCIETAL CONTEXT OF MENTAL HEALTH CARE 195 -- 2.5.1 Political context 195 -- 2.5.2 Societal context 197 -- 3 CONCLUSION 198 -- 3.1 MAIN FINDINGS 198 -- 3.1.1 Provision 198 -- 3.1.2 Access to mental healthcare 199 -- 3.1.3 Mental healthcare coordination and collaboration 199 -- 3.1.4 Financing mechanisms 200 -- 3.1.5 Political context 200 -- 3.2 RECURRING CONTROVERSIES 200 -- 3.2.1 Priorities of the system 200 -- 3.2.2 Designing and building bridges in the mental healthcare system 201 -- 3.2.3 Paradigm shift and power divisions: policy-makers, professionals and the public 202 -- 3.3 REFLECTION ON THE RESEARCH PROCESS, MAIN LIMITATIONS AND NEXT STEPS 203 -- 3.3.1 Social embeddedness 203 -- 3.3.2 Limitations of this research 203 -- 3.3.3 The next steps 205 -- 4 REFERENCES 205 -- CHAPTER 07 VALUES AND SETS OF POSSIBLE ORGANISATIONAL SOLUTIONS: A CHOICE- BASED STAKEHOLDER ANALYSIS SURVEY 207 -- AUTHORS: SMITH P1, NICAISE P1, NEYENS I2, HERMANS K2, THUNUS S1, WALKER C1, VAN AUDENHOVE C2, LORANT V1 207 -- 1 INTRODUCTION: A TRANSITION TO MENTAL HEALTH CARE FOCUSED ON COMMUNITY CARE AND SOCIAL INTEGRATION 207 -- 2 OBJECTIVES 207 -- 3 DESIGN 208 -- 3.1 DEFINITIONS 209 -- 3.2 MATERIAL AND METHODS 209 -- 3.2.1 First part of the survey 209 -- 3.2.2 Second part of the survey 210 -- 3.2.3 Third part of the survey 212 -- 3.2.4 Part four to seven of the survey 214 -- 3.2.5 Validation of the content 214 -- 3.2.6 Sampling 215 -- 3.2.7 Data collection procedure 218 -- 3.2.8 Selection bias related to non-respondents 218 -- 3.3 DATA ANALYSIS 218 -- 4 RESULTS 220 -- 4.1 SAMPLING AND STAKEHOLDERS’ CHARACTERISTICS 220 -- 4.2 PRIORITY OBJECTIVES OF THE REFORM IN MENTAL HEALTH CARE IN BELGIUM 221 -- 4.3 DIFFERENCES BETWEEN REGIONS AND STAKEHOLDERS IN PRIORITY OBJECTIVES OF THE REFORM IN MENTAL HEALTH CARE 222 -- 4.4 COMPARISONS BETWEEN GOALS, SOCIAL INTEGRATION OR CARE IN THE COMMUNITY 224 -- 4.4.1 Differences in priority organisational interventions according to the objective to be achieved 224 -- 4.4.2 Differences in levels of the organisation of mental health care implicitly preferred according to the objective to be achieved 225 -- 4.5 CONJOINT ANALYSIS: EXPLICIT VALUES THAT UNDERLIE THE EXPECTATIONS ON THE ORGANISATION OF MENTAL HEALTH CARE IN BELGIUM 226 -- 4.5.1 Utility and importance of dimensions and levels of the organisation of mental health care 226 -- 4.5.2 Differences between regions and stakeholders in priority levels of the organisation of mental health care228 -- 4.5.3 A different organisation of mental health care according to the target group? 232 -- 4.6 ORGANISATIONAL INTERVENTIONS: PRIORITIES AND PREFERENCES 233 -- 4.6.1 Stakeholders' prioritized organisational interventions, for the overall sample, by region and by stakeholders’ profile 233 -- 4.6.2 Stakeholders' preferred organisational interventions 237 -- 4.6.3 Clustering of organisational interventions 239 -- 4.7 IMPLICIT VALUES OF THE ORGANISATION OF MENTAL HEALTH CARE BEHIND SELECTED ORGANISATIONAL INTERVENTIONS 242 -- 4.8 INTERVIEWS WITH STAKEHOLDERS 244 -- 4.8.1 Priority objectives of the reform in mental health care 244 -- 4.8.2 Conjoint analysis on the dimensions and levels of the organisation of mental health care 245 -- 4.8.3 Organisational interventions 247 -- 4.8.4 Final comment 249 -- 4.9 STAKEHOLDER COMMENTS IN THE ONLINE SURVEY 250 -- 5 CONCLUSION 251 -- 5.1 INTERPRETATION OF FINDINGS AND COMPARISON WITH PREVIOUS LITERATURE 251 -- 5.1.1 Objectives of the mental health care system 251 -- 5.1.2 A different mental health care organisation according to the target group? 253 -- 5.1.3 Coordination between providers and formalization of patients’ care pathways 255 -- 5.1.4 Funding of mental health care 256 -- 5.1.5 Organisational interventions focused on access to care 256 -- 5.1.6 Differences between stakeholders 257 -- 5.1.7 Differences between regions 258 -- 5.2 STRENGTHS AND LIMITATIONS 259 -- 5.3 FINAL RECOMMENDATIONS BASED ON THE QUALITATIVE AND QUANTITATIVE FINDINGS 259 -- 6 REFERENCES 266 -- CHAPTER 08 ACCEPTABILITY OF POSSIBLE RECOMMENDATIONS FOR FUTURE MENTAL HEALTH CARE ORGANISATION IN BELGIUM: A STAKEHOLDER SURVEY 272 -- AUTHORS: CORNELIS J1, DETOLLENAERE J1, DEVRIESE S1, MISTIAEN P1, RICOUR C1. 272 -- 1 INTRODUCTION 272 -- 2 METHOD 272 -- 2.1 CONSTRUCTION OF THE SURVEY 272 -- 2.2 STATISTICAL ANALYSIS OF THE ANSWERS 273 -- 3 RESULTS 274 -- 3.1 DESCRIPTION OF THE SAMPLE 274 -- 3.2 RESULTS OF THE MAIN THEMES 274 -- 3.2.1 Policy 274 -- 3.2.2 Intervention 276 -- 3.2.3 Registry 277 -- 3.2.4 Access 278 -- 3.2.5 Registration 280 -- 3.2.6 Research 281 -- 3.2.7 Participation 281 -- 3.2.8 Financing 282 -- 3.2.9 Priority 283 -- 3.2.10 Stigmatizing or health literacy 284 -- 3.2.11 Inclusion 284 -- 3.2.12 Cooperation 285 -- 3.2.13 Quality 286 -- 3.2.14 Respondent opinion on what to change 288 -- 3.3 RESULTS OF THE SUB-ANALYSES 289 -- 3.3.1 Sub-analysis by region of the organisation 289 -- 3.3.2 Sub-analysis by care organisation 289 -- 4 DISCUSSION 289 -- 5 KEY MESSAGES 291 -- 6 REFERENCES 292 -- APPENDICES 29
« Diminuer son cholestérol avec des médicaments ? Le pour et le contre » : un outil d’aide à la décision pour les médecins généralistes – Synthèse
No full text17 p.ill.,Un quart des Belges de plus de 40 ans prennent un médicament de la classe des statines pour faire baisser leur taux de cholestérol. Or, si le bénéfice de ces médicaments est clair chez les personnes qui ont déjà eu des problèmes cardiovasculaires (infarctus, AVC), il est moins net chez celles qui n’en ont jamais eu. De plus, les effets secondaires de ces médicaments peuvent être importants. Il est donc nécessaire de bien peser le pour et le contre, au cas par cas, avant de les prescrire. Le Centre fédéral d’Expertise des Soins de santé (KCE) a développé un outil interactif permettant de visualiser les bénéfices et les risques des statines. Cet outil est essentiellement destiné aux médecins généralistes, afin de les aider à discuter avec leurs patients du choix d’en prendre ou pas.PRÉFACE 1 -- SYNTHÈSE 2 -- 1. CONTEXTE DE CE RAPPORT 3 -- 2. ÉTAPES THÉORIQUES PRÉALABLES AU DÉVELOPPEMENT DE L’OUTIL 4 -- 2.1. ANALYSE DES OUTILS EXISTANTS 4 -- 2.2. CHOIX DU SYSTÈME D'ÉVALUATION DU RISQUE CARDIOVASCULAIRE SCORE 5 -- 2.3. QUANTIFICATION DE L’IMPACT DES STATINES 8 -- 3. DÉVELOPPEMENT DE L’OUTIL 9 -- 3.1. CHOIX D'UN OUTIL EN LIGNE 9 -- 3.2. DÉVELOPPEMENT DU CONTENU DE L’OUTIL 9 -- 3.2.1. La page d'accueil 9 -- 3.2.2. La page de test 10 -- 3.2.3. La page d’information du patient 12 -- 3.2.4. La page 'À propos de ce site' 13 -- 3.2.5. La « lettre au patient » 13 -- 3.3. DÉVELOPPEMENT TECHNIQUE DU SITE WEB 13 -- 3.3.1. Spécifications techniques 13 -- 3.3.2. Validation des algorithmes 14 -- 4. ÉVALUATION DE L’OUTIL 14 -- 4.1. ÉCHANTILLONS 14 -- 4.2. RÉSULTATS 15 -- 5. MISE À DISPOSITION DE L’OUTIL 16 -- RECOMMANDATIONS 1
Gezondheidsgeletterdheid : welke lessen trekken uit de ervaring van andere landen? – Synthese
No full text27 p.ill.,‘Gezondheidsgeletterdheid’ is het vermogen van een persoon om informatie over gezondheid te begrijpen, zodat hij zijn gezondheid en levenskwaliteit kan behouden of verbeteren. In België blijkt 30 tot 45% van de bevolking een problematisch niveau van gezondheidsgeletterdheid te hebben. Vele landen namen al maatregelen om de gezondheidsgeletterdheid van hun inwoners te verbeteren. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) kreeg de opdracht om hun actieplan te onderzoeken, om er lessen uit te kunnen trekken voor een eventueel Belgisch plan. Idealiter worden alle sectoren van de maatschappij (onderwijs, werkgelegenheid, enz.) mee in het bad getrokken, maar in de eerste plaats vooral toch de professionals en gezondheidsorganisaties. Vandaag is er al veel expertise aanwezig, maar de initiatieven worden best beter op elkaar afgestemd.VOORWOORD 1 -- SYNTHESE 2 -- 1. INLEIDING 4 -- 1.1. WAT IS GEZONDHEIDSGELETTERDHEID? 4 -- 1.2. WAT IS HET GEZONDHEIDSGELETTERDHEIDNIVEAU VAN DE BELGISCHE BEVOLKING? 6 -- 1.3. DOELSTELLINGEN EN METHODES VAN DIT RAPPORT 7 -- 2. INTERNATIONALE VERGELIJKING 8 -- 2.1. WAAROM WERDEN DE ACTIEPLANNEN GELANCEERD? 8 -- 2.2. HOE ZIJN DE ACTIEPLANNEN UITGEWERKT? 9 -- 2.2.1. Wie nam het initiatief voor de plannen? 9 -- 2.2.2. Hoe werden de plannen opgesteld? 10 -- 2.2.3. Welke financiële middelen werden ingezet? 11 -- 2.3. WAT IS DE INHOUD VAN DE ACTIEPLANNEN? 12 -- 2.3.1. Wie zijn de begunstigden? 12 -- 2.3.2. Wat zijn de aangekondigde doelstellingen? 12 -- 2.3.3. Welke interventies worden voorgesteld? 14 -- 2.4. HOE WORDEN DE ACTIEPLANNEN GEËVALUEERD? 16 -- 2.4.1. Wat zijn de bewijzen van doeltreffendheid? 16 -- 2.4.2. Wat weten we over de concrete impact van de actieplannen? 17 -- 3. TE VERKENNEN PISTES TER VOORBEREIDING VAN EEN BELGISCH ACTIEPLAN 17 -- 3.1. DRIE TE OVERWEGEN PISTES 17 -- 3.1.1. Een conceptueel actieplan? 17 -- 3.1.2. Een pragmatisch actieplan? 18 -- 3.1.3. …of geen actieplan? 18 -- 3.2. HOE DE OMSTANDIGHEDEN VOOR SUCCES CREËREN? 19 -- 3.2.1. Beleid 19 -- 3.2.2. Ontwikkeling van de kennis 20 -- 3.2.3. Versterken van de zorgverleners 21 -- 3.2.4. Organisatorische geletterdheid van de instellingen 21 -- 3.2.5. Partnerschappen 22 -- 3.2.6. Financiële middelen 23 -- AANBEVELINGEN 2
Safe nurse staffing levels in acute hospitals : Short Report
No full text61 p.ill.,FOREWORD 1 -- SYNTHESIS 2 -- 1. BACKGROUND 4 -- 1.1. THE BELGIAN NURSING WORKFORCE: A CONTEXT DESCRIPTION 5 -- 1.1.1. Two main educational pathways to enter the nursing profession 5 -- 1.1.2. The nursing workforce: facts and figures 5 -- 1.1.3. Nurse staffing levels in acute hospitals: licensing standards and hospital payment system 6 -- 1.2. THE IMPORTANCE OF ADEQUATE STAFFING LEVELS AND A GOOD NURSING WORK ENVIRONMENT 7 -- 1.2.1. Nurse staffing and outcomes are clearly associated but the relationship is complex 7 -- 1.2.2. Bedside nurse staffing levels in Belgian hospitals are known to be low in a European context 8 -- 1.3. A HOSPITAL LANDSCAPE IN EVOLUTION AND POTENTIAL IMPACT ON NURSING CARE 8 -- 1.4. STUDY OBJECTIVES – SCOPE AND APPROACH 9 -- 2. EVOLUTION IN THE INTENSITY OF NURSING CARE AND NURSE STAFFING LEVELS IN BELGIAN HOSPITALS 13 -- 2.1. EVOLUTION IN INTENSITY OF NURSING CARE AND NURSE STAFFING LEVELS 14 -- 2.1.1. Intensity of nursing care 14 -- 2.1.2. Nurse staffing levels 17 -- 2.1.3. Are nurse staffing levels adequate? 17 -- 2.1.4. Supporting staff 19 -- 2.2. RELATIONSHIP BETWEEN NURSE STAFFING LEVELS AND THE HOSPITAL BUDGET 19 -- 3. NURSE STAFFING LEVELS AND NURSING WORK ENVIRONMENT IN BELGIAN HOSPITALS 20 -- 3.1. NURSING WORK ENVIRONMENT 20 -- 3.2. NURSE STAFFING LEVELS 23 -- 3.2.1. Patient-to-nurse ratios 23 -- 3.2.2. Proportion of Bachelor-prepared nurses 24 -- 3.3. NURSING ACTIVITIES 24 -- 3.3.1. Care left undone as reported by nurses 24 -- 3.3.2. Non-nursing tasks 26 -- 3.4. NURSE OUTCOMES 26 -- 3.4.1. Risk of burnout 26 -- 3.4.2. Job dissatisfaction and intention to leave 28 -- 3.5. NURSE-PERCEIVED QUALITY OF CARE 28 -- 3.6. THE IMPACT OF FACTORS OF THE NURSING WORK ENVIRONMENT AND STAFFING ON (NURSE) OUTCOMES 28 -- 4. INTERNATIONAL SAFE STAFFING POLICIES 29 -- 4.1. BACKGROUND 29 -- 4.2. NURSING EDUCATION AND SKILL MIX 30 -- 4.3. WHY WERE ‘SAFE STAFFING POLICIES’ DEVELOPED? 30 -- 4.4. POLICY OPTIONS VARY FROM FLEXIBLE TO RIGID AND FROM LIMITED IN SCOPE TO VERY COMPREHENSIVE 31 -- 4.5. COMMON ELEMENTS AND OBJECTIVES OBSERVED IN SAFE STAFFING POLICIES 34 -- 4.6. IMPACT OF SAFE STAFFING POLICIES 35 -- 5. TOWARDS A SAFE STAFFING POLICY IN BELGIAN ACUTE HOSPITALS 37 -- 5.1. IMPROVE PATIENT-TO-NURSE RATIOS IN ACUTE HOSPITALS 37 -- 5.1.1. Use the nursing expertise for nursing care 45 -- 5.1.2. Simplify the hospital payment system and ensure a fair allocation system of (additional) resources for nurse staffing 45 -- 5.1.3. Nurse staffing levels on geriatric wards require specific attention 46 -- 5.2. A SAFE STAFFING POLICY AT THE MACRO-LEVEL 47 -- 5.2.1. Data-information system to inform and monitor a safe-staffing policy 47 -- 5.2.2. Evaluate the impact in a pro-active and systematic way 49 -- 5.3. STAFFING MATTERS FROM BOARD TO BEDSIDE 50 -- 5.3.1. Building a good environment for nurses with attention for staffing levels from board to bedside 50 -- 6. CONCLUSION 52 -- REFERENCES 53 -- RECOMMENDATIONS 5
Cost sharing and protection mechanisms in health : Examples of Hypothetical simulations: Results
No full text98 p.ill.,SCIENTIFIC REPORT .7 -- 1 INTRODUCTION 7 -- 1.1 GENERAL BACKGROUND .7 -- 1.2 SCOPE OF THE STUDY 8 -- 1.3 RESEARCH METHODS AND OVERVIEW OF THE REPORT .9 -- 2 CHANGES IN SOCIAL PROTECTION MECHANISMS BETWEEN 2012 AND 2016 10 -- 2.1 SUMMARY OF POLICY CHANGES .10 -- 2.2 ESTIMATING THE DIFFERENCE BETWEEN OMNIO BENEFICIARIES AND COMPLETE TAKE-UP FOR THE OMNIO STATUS .12 -- 2.2.1 Complete take-up for the OMNIO status 12 -- 2.3 LIMITING THE TRANSFER OF THE ENTITLEMENT TO OMNIO TO MEMBERS OF THE ‘REFERENCE’ HOUSEHOLD 18 -- 2.3.1 Transfer of the entitlement to OMNIO to members of the reference household 18 -- 2.4 SIMPLIFICATION OF THE SYSTEM OF INCREASED REIMBURSEMENT 20 -- 2.4.1 Increased reimbursement in 2014 20 -- 2.4.2 Impact of a systematic control: households losing the right to increased reimbursements 28 -- 2.4.3 Impact of changing the reference household definition 29 -- 2.5 CHILD MAB FOR HANDICAPPED CHILDREN 30 -- 2.6 POLICIES FOR PERSONS WITH A CHRONIC ILLNESS 33 -- 2.6.1 Situation before 2014: impact of the MAB for the chronically ill 33 -- 2.6.2 Situation after 2014: introduction of the status of person with chronic illness 37 -- 2.6.3 Status of a person with a chronic illness 41 -- 3 INTRODUCTION OF NEW CHANGES IN SOCIAL PROTECTION MECHANISMS .45 -- 3.1 SUMMARY OF NEW POLICY MEASURES .45 -- 3.2 RESTRICTING THE MAB FOR THE CHRONICALLY ILL (N_7) TO AVOID OVERLAP WITH THE STATUS OF A PERSON WITH A CHRONIC ILLNESS .48 -- 3.3 ABOLISHING THE RIGHT TO INCREASED REIMBURSEMENT FOR HOUSEHOLDS WITH AN INCOME ABOVE THE THRESHOLD (N_8) .51 -- 3.4 INCLUDING STAYS IN A PSYCHIATRIC HOSPITAL IN THE MAB COUNTER 56 -- 3.5 ESTIMATION OF THE MAB CEILING BASED ON THE NET INCOME OF THE PREVIOUS YEAR .60 -- 3.6 FISCAL REFORMS: SHIFT FROM TAX DEDUCTIONS TO TAX REDUCTIONS 66 -- 3.7 MODIFICATION TO THE MAB SYSTEM: ABOLISHING THE SOCIAL MAB AND INTRODUCING A CEILING OF € 250 FOR LOW-INCOME HOUSEHOLDS .72 -- 3.7.1 Abolishing the social MAB and introducing a ceiling of € 250 for low-income households based on the net taxable income (NTI) of 2009 72 -- 3.7.2 Abolishing the social MAB and introducing a ceiling of € 250 for low-income households based on the net taxable income (NTI) of 2011 78 -- 3.8 INDEXATION ON THE INCOME MAB THRESHOLDS AND CEILINGS 84 -- 3.8.1 Indexation of the MAB ceilings 84 -- 3.8.2 Indexation of the MAB income thresholds 88 -- 3.8.3 Changes in the number of households entitled to the social and income MAB: analysis in -- light of the simulation results 92 -- 3.9 INCOME-RELATED DEDUCTIBLE EXCLUDING GP SERVICES 93 -- REFERENCES .9
Proposals for a more effective antibiotic policy in Belgium : Short Report
No full text36 p.ill.,KEY MESSAGES 2 -- SHORT REPORT 3 -- 1. BACKGROUND 8 -- 1.1. RATIONALE, RESEARCH QUESTIONS & SCOPE 8 -- 1.2. METHODOLOGY 9 -- 2. WHICH INITIATIVES HAVE BEEN TAKEN SINCE 1999? 10 -- 2.1. HUMAN SECTOR 10 -- 2.2. VETERINARY SECTOR 11 -- 3. WHAT IS THE CURRENT SITUATION OF ANTIBIOTIC USE IN BELGIUM? 13 -- 3.1. HUMAN SECTOR 13 -- 3.1.1. Ambulatory sector 13 -- 3.1.2. Hospital sector 13 -- 3.1.3. Nursing homes 14 -- 3.1.4. Self-medication with antibiotics and knowledge on antibiotics 14 -- 3.2. VETERINARY SECTOR 15 -- 4. WHY DO THE PRESCRIPTION AND USE OF ANTIBIOTICS STAY AT A HIGH LEVEL IN BELGIUM? 16 -- 4.1. AT THE LEVEL OF THE INDIVIDUAL PRESCRIBERS AND USERS 16 -- 4.2. AT THE LEVEL OF HEALTHCARE INSTITUTIONS AND ANIMAL FARMS 16 -- 4.3. AT THE POLICY LEVEL 17 -- 5. HOW CAN THE SITUATION BE IMPROVED? 18 -- 5.1. DEVELOP A NATIONAL ONE HEALTH AMR ACTION PLAN 18 -- 5.2. STRENGTHEN ANTIBIOTIC STEWARDSHIP IN ACUTE CARE HOSPITALS 19 -- 5.3. ROLL OUT LOCAL ANTIBIOTIC STEWARDSHIP TEAMS IN THE AMBULATORY SECTOR 19 -- 5.4. DEVELOP ANTIBIOTIC STEWARDSHIP IN NURSING HOMES 20 -- 5.5. IMPROVE THE PROFESSIONAL EDUCATION ON PRUDENT ANTIBIOTIC PRESCRIPTION AND USE, AND DEVELOP AND IMPLEMENT INTERVENTIONS TARGETING PSYCHOLOGI CAL, SOCIAL AND INSTITUTIONAL DETERMINANTS OF BEHAVIOURAL CHANGE 21 -- 5.6. RECOGNISE MEDICAL MICROBIOLOGY AND INFECTIOLOGY AS MEDICAL SPECIALTY AND PROVIDE REMUNERATION FOR THEIR ADVICE 22 -- 5.7. IMPROVE THE AVAILABILITY OF OLD/NARROW SPECTRUM ANTIBIOTICS 22 -- 5.8. PUT INTO PRACTICE THE DELIVERY OF THE EXACT NUMBER OF ANTIBIOTIC TABLETS IN PHARMACIES OPEN TO THE PUBLIC 22 -- 5.9. IMPROVE THE COMPLIANCE WITH EVIDENCE-BASED PRESCRIPTION GUIDELINES 23 -- 5.10. MAKE USE OF THE (FUTURE) MANDATORY IMPLEMENTATION OF E-PRESCRIBING TO IMPROVE THE PRUDENT PRESCRIPTION OF ANTIBIOTICS 23 -- 5.11. CONSIDER TAKING STRUCTURAL MEASURES TO IMPROVE THE PRUDENT PRESCRIPTION AND USE OF ANTIBIOTICS 24 -- 5.12. PERFORM A HEALTH TECHNOLOGY ASSESSMENT ON POINT-OF-CARE TESTING FOR THE DIAGNOSIS OF INFECTIOUS DISEASES IN THE BELGIAN AMBULATORY CARE CONTEXT 24 -- 5.13. STIMULATE BEHAVIOURAL CHANGE AMONG THE GENERAL PUBLIC AS WELL AS THE PRESCRIBERS TOWARDS MORE PRUDENT USE OF ANTIBIOTICS 24 -- 5.14. STRENGTHEN VETERINARIANS’ COUNSELLING ROLE 25 -- 5.15. CHANGE PRESCRIBING BEHAVIOUR OF HIGH ANTIBIOTIC PRESCRIBERS 25 -- 5.16. MONITOR AND STIMULATE RESEARCH ON ANTIBIOTIC USE AND AMR IN THE SECTOR OF COMPANION ANIMALS 26 -- 5.17. STIMULATE BIOSECURITY IMPROVEMENTS AS AN ALTERNATIVE TO ANTIBIOTIC USE 26 -- 5.18. ENFORCE COMPLIANCE WITH THE LEGISLATION ON ANIMAL WELFARE 27 -- 5.19. MAKE THE USE OF ANTIBIOTICS AS MEANS TO INTENSIFY ANIMAL PRODUCTION SUPERFLUOUS 27 -- 5.20. AVOID SELF-MEDICATION BY MINIMIZING STOCKS AT FARMS AND BY ADJUSTING PACKAGE SIZES 27 -- 5.21. DEFINE NEW GOALS REGARDING ANTIBIOTICS IN THE VETERINARY SECTOR 28 -- 6. REFERENCES 2